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PATIENT QUESTIONNAIRE Your Name: Height: Weight: TPR: B/P 02SAT birthplace: Current township: If retired, occupation prior to retirement: Maiden name Medical physician: Surgeon: Name of Person to
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Start by writing your full name in the designated field.
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Enter your height in feet and inches or in centimeters, depending on the format required.
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Provide your weight in pounds or kilograms, as specified.
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Healthcare professionals might require your name, height, and weight for medical records and assessments.
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My name is [NAME], my height is [HEIGHT] and my weight is [WEIGHT]
The person filing could be the individual themselves or a designated representative, in some cases it may be required by a healthcare professional.
The form can be filled out either online or in person, providing accurate information about your name, height, and weight.
The purpose is to document personal identifying information for various purposes such as healthcare, record-keeping, or identification purposes.
The information that must be reported includes your full name, accurate height measurement, and weight measurement.
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